reliable and allow for spontaneous sexual activity. After appropriate placement of an implant, the penile shaft can become 100% rigid by pumping up the device, which typically takes 30–60 s [5]. The main disadvantages to penile implant surgery include the need for general anesthesia and the risks of surgery. The risk of infection is typically less than 2%, but higher in cases of revision and replacement or if the patient is diabetic, and mechanical failure of the implant is typically 15% within therst 10 years after placement. It is important to provide patients with adequate resources including instructional videos, device demonstration, and access to patient advocates, and involve their partners in surgical counseling prior to making the decision to have penile implant surgery.

In conclusion, erectile dysfunction can be due to various etiologies; however, there are many viable treatment options available. Importantly, ED can be a harbinger of underlying cardiovascular disease, and these men must be referred to cardiology for evaluation. It also is important to stress that a fraction of patients will present with erectile dysfunction that cannot be explained by any of the described etiolo- gies—and in these men, it is important to note that psychological stressors (anxiety and depression) may play a big role in their pathology. In these men, it is imperative to treat their symptoms (i.e., prescribing PDE5i or other medication) and to refer them to a mental health professional who can assist with their psychological stressors. Finally, it is important to note that although there are various treatment options, the nal treatment plan offered should be based on the desires of the patient and their partner, with the risks, bene ts, and alternatives thoroughly discussed.

References

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2.\ Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–41.

3.\ Raina R, Pahlajani G, Agarwal A, Zippe CD. Treatment of erectile dysfunction: update. Am J Mens Health. 2007;1(2):126–38.

4.\ Mulhall JP, Stahl PJ, Stember DS. Clinical care pathways in andrology. New York, NY: Springer Science; 2014.

5.\ Habous M, Tal R, Tealab A, Azi M, Sherif H, Mahmoud S, et al. Predictors of satisfaction in men after penile implant surgery. J Sex Med. 2018;15(8):1180–6.